How Do We Reduce Gun Violence? Some Doctors Dont Have a Clue.


              Almost thirty years ago, before Columbine, before Sandy Hook, before Uvalde, two physicians cum researchers, Art Kellerman, and Fred Rivara, published studies which identified guns in the home as a medical risk. And the risk wasn’t some fever or rash. The risk was death.

              Know a more serious medical risk?  I don’t.

              Not only did Kellerman and Rivara define the medical risk caused by access to guns, but the risk wasn’t qualified or lessened if the guns were safely stored, or if the gun owner was more ‘responsible,’ or anything else. Guns equal medical risk. Or to quote Grandpa, ‘prust und prushit’ (read: that’s enough of that.)

              What has happened since those articles appeared?  The gun industry and their supporters have denied the whole thing, but why would they do anything else? They want to sell guns. And tobacco companies want to sell cigarettes. Fine. Good for them.

              On the other hand, you would expect that the medical and public health communities would respond to the identification of guns as a health risk by saying what they are supposed to say about any risk to health, which is – get rid of the risk.

              So, here we go again with another debate about guns provoked by yet another savage, mass assault in a school, and what are we hearing from doctors and public health researchers?

              We are hearing that we have to find some ways to prevent those mass slaughters from happening but oh, by the way, law-abiding adults should still be able to own a gun.

              I have been listening to this same bullsh*t now for more than twenty-five years, and frankly, my friends in medicine and public health, along with my friends in all those gun-control organizations who say the same thing should be ashamed of themselves.

              You don’t identify a risk to health and then try to figure out a way to make people healthier but still keep the risk in place.

              Am I missing something here? I don’t think so.

              Ands the best of all are those physicians who go around claiming that we can reduce the risk from guns by getting together with gun owners and coming up with a ‘consensus’ approach that will protect everyone from getting shot but at the same time allow potential shooters to keep their guns.

              Do the so-called experts in medicine and public health who promote such nonsense actually believe here’s a single gun nut out there who thinks that Mike Bloomberg is all of a sudden interested in protecting their ‘rights?’ Give me a break.

              Yea, yea, I know that Americans own somewhere between 300 million and 400 million guns. So what? Most of these guns happen to be guns that have never figured in any kind of gun violence at all. The guns which cause gun violence – semi-automatic, hi-capacity handguns and rifles – weren’t even sold until the late 1970’s or early 1980’s. 

How many of those 400 million guns which comprise the current civilian arsenal were manufactured before 1978?  Plenty. And let’s not forget that guns aren’t like cars. They don’t wear out.

And by the way, ATF already makes a distinction between guns that are used for killing human beings as opposed to guns that are used for hunting and sport.  Want to import a gun from overseas which doesn’t meet the ATF’s requirements for being a ‘sporting’ gun? You can’t.

Why do you think Glock makes their guns in Georgia, Sig has a factory in New Hampshire and Beretta has a factory in Accokeek, MD? That’s where they make the kinds of guns that are used to kill and injure 300 Americans every day. Sorry, but Grandpa’s old shotgun rusting away in a corner of the garage isn’t a threat to health.

              Either we get rid of the guns which are a risk to health, or we don’t. And it’s about time that the physicians and public health researchers who posture themselves as ‘experts’ on gun violence stop looking for easy answers which will do nothing and start making arguments based on the facts.

What Can Doctors Do To Reduce Gun Violence? Tell Us What Only They Know.

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Next week’s issue of the New England Journal of Medicine will contain an editorial, “Guns, Society and Medicine,” written by the Journal’s former editor, Jerome Kassirer.  This editorial follows hard on the heels of another editorial, “Preventing Firearm Injury and Death” which just appeared in the Annals of Internal Medicine.  The good news about these statements is that they appear to reflect a growing consensus in the medical community that physicians should play a more active role in the debate about guns.  The bad news, it seems to me, is that the manner in which physicians appear to be lining up to engage in the debate may actually diminish the value of what they have to say.

The statement in the Annals, signed off by eight medical professional organizations (AAP, ACEP, ACP, etc.) calls for vigorous support of the following measures: universal background checks, elimination of physician “gag” laws, restrictions on the sale of assault rifles and high-capacity feeding devices, additional research, improved mental health services and avoidance of stigmatization through non-specific reporting laws.  These measures were adopted by the eight medical societies after the American Bar Association confirmed that they did not conflict with 2nd-Amendment rights.

conference program pic                In his NEJM editorial, Jerome Kassirer voices his support for these same measures but notes that gun-safety advocates appear to be losing the battle due primarily to the “reality that gun-control advocates are ’outgunned’  by the NRA.”  It should be noted, inter alia, that in the twelve months following Sandy Hook, dues received by the NRA jumped more than 60% from $108 million in 2012 to $175 million in 2013, an increase due to the ability of the organization to sell the idea that the public outcry over what happened in Newtown would result in all guns being taken away.

I have been listening to gun-safety advocates bemoan the political power and financial muscle of the NRA for more than twenty years while, at the same time, researchers continue to publish articles which rightly demonstrate that the losses from gun ownership outweigh the gains.  There simply is no question that scholars like Hemenway, Cook, Webster and so many others have produced a body of literature about gun risk that cannot be honestly challenged by the other side.  But the other side isn’t interested in participating in a scholarly debate.  The other side is interested in selling guns.  And as long as guns are legal commerce, why shouldn’t it be up to the individual consumer to decide whether gun ownership represents a risk?

The answer to that question, and the role that I believe physicians should play in the gun debate can be found in a substantive piece of research that was also published this week in the Annals.  This work covered the medical histories of everyone discharged in 2006-2007 from an ER in Washington State and found that the patients who were admitted for a gun injury, particularly if they had a previous gun or violence-related arrest, had a significantly higher chance of coming either back to the ER with another injury or winding up in the morgue.  The research plan focused primarily on more than 9,000 patients who were treated for violent injuries, of whom 680 were in the ER because they were injured with guns.

What seems to be missing from the recommendations to reduce gun violence proposed by the medical associations and echoed by Dr. Kassirer is the fact that in the Seattle study, each of those 680 patients represented at least one direct, face-to-face contact with a clinician who had to deal with the medical risk of guns.  Thanks to data mining, we know a lot about the demographic profiles of these patients, but only the physician who treated them was in a position to ask and possibly learn what happened, why it happened, and whether it would happen again.  The answers to those questions and how those answers could shape policy, is a contribution to the gun debate that only doctors can make.